Disinfection of flexible fibre-optic endoscopes out-of-hours: confidential telephone survey of ENT units in England – 10 years on

Radford, PD; Unadkat, SN; Rollin, Matthew; Tolley, NS

doi:10.1017/s0022215113000613

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…The typical steps in standard HLD disinfection are intricate: removal of debris/precleaning, leak testing, immersion, and cleaning of each component with detergent and an HLD reagent, and finally drying with alcohol and air 2,14 . Methods for endoscope reprocessing vary widely; some protocols rely on automated endoscope reprocessor units whereas others require manual processing 11 . One survey on nasopharyngoscope disinfection showed that, with the exception of soaking in an HLD solution, compliance with HLD steps was less than 51% 14 .…”

Section: Discussionmentioning

confidence: 99%

“…Published guidelines have emphasized the importance of nasopharyngoscope decontamination, 5,6 but few have specified an exact reprocessing protocol comparable to those established for bronchoscopes and duodenoscopes 7–9 . As a result, considerable variability in methods used for reprocessing nasopharyngoscopes exists across hospitals in the United States and internationally 10,11 …”

Section: Introductionmentioning

confidence: 99%

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A Manufacturer and User Facility Device Experience Analysis of Upper Aerodigestive Endoscopy Contamination: Is Flexible Laryngoscopy Different?

et al. 2020

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Objectives/Hypothesis Several recent studies have observed a high incidence of duodenoscope microbial contamination and an association of contamination with healthcare‐acquired infections. This study sought to quantify nasopharyngoscope microbial contamination relative to that of other endoscope categories and characterize the manufacturers, outcomes, and microbial profiles associated with these cases. Study Design Retrospective, cross‐sectional study. Methods A total of 3,865 adverse events were collected from 2013 to 2019 using the US Food and Drug Administration Manufacturer and User Facility Device Experience database. The fraction of total device failures associated with contamination was quantified for nasopharyngoscopes, bronchoscopes, duodenoscopes, and gastroscopes. Odds ratios of nasopharyngoscope contamination compared to that of bronchoscopes, duodenoscopes, or gastroscopes were calculated, and significance was assessed by χ2 analysis. The Kruskal‐Wallis test was used for nonparametric testing of significance. Results Nasopharyngoscope device failures were reported at an incidence of 0.646 per month; 34.1% involved contamination, comparable to the frequency observed for bronchoscopes (23.4%, P = .118), duodenoscopes (29.2%, P = .493), and gastroscopes (45.3%, P = .178). The frequency of device contamination was observed to be significantly higher for a particular endoscope manufacturer regardless of endoscope category (Kruskal‐Wallis P = .021). In instances of contamination, nasopharyngoscopes were significantly less associated with patient harm or death than bronchoscope (odds ratio [OR] = 10.2) and duodenoscope (OR = 4.81) cases. Conclusions Although the rates of contamination were comparable across all endoscope categories, nasopharyngoscope contamination was less commonly associated with patient harm or death. In an era of rising healthcare costs, determining adequate disinfection standards for nasopharyngoscopes and their impact on patient safety is crucial. Level of Evidence NA Laryngoscope, 131:598–605, 2021

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Manufacturer and User Facility Device Experience Analysis of Upper Aerodigestive Endoscopy Contamination: Is Flexible Laryngoscopy Different?

et al. 2020

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“…This is a particular problem in the out-of-hours setting when normal back-up facilities for disinfection are not available. In their survey, Radford and colleagues 4 found that there was widespread non-compliance with 2005 ENT-UK guidelines, and they point out the need for urgent action to ensure best practice. Depressingly, this study showed that little had improved in the 10 years since a previous assessment of UK practice 5 …”

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confidence: 99%

Management of the most common ENT presentations

Youngs¹,

Fisher²

2013

J. Laryngol. Otol.

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Articles in this issue of the JLO provide insight into the management of some of the most common caseload seen in ENT practice. Firstly, there are the many patients who present to ENT clinics with medically unexplained symptoms. These patients form a large part of out-patient workload and include those with symptoms such as dizziness, tinnitus, blocked ears, catarrh, atypical facial pain, throat lumps and dysphonia. These are patients with symptoms but with no demonstrable pathology on examination or investigation. In their excellent review of these conditions, Ullas and colleagues 1 stress the importance of consultations that recognise the symptoms and their impact, rather than adopting a purely dismissive stance. There is now much more of an emphasis on psychological factors due to an association with anxiety and depression.Another article considers the management of epistaxis in anticoagulated patients, a condition which now constitutes the most frequent cause of emergency admission in UK ENT units. These patients often pose significant management challenges, particularly in regard to their anticoagulant medication.2 Biggs and colleagues 3 propose a treatment algorithm which if implemented would help standardise the management of epistaxis patients, and should reduce morbidity associated with unnecessary routine discontinuation of such medication.Another recurrent theme in the context of hospitalacquired infections is the optimum method of disinfection of flexible fibre-optic endoscopes. This is a particular problem in the out-of-hours setting when normal back-up facilities for disinfection are not available. In their survey, Radford and colleagues 4 found that there was widespread non-compliance with 2005 ENT-UK guidelines, and they point out the need for urgent action to ensure best practice. Depressingly, this study showed that little had improved in the 10 years since a previous assessment of UK practice. ROBIN YOUNGS EDWARD FISHER Editors

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National prospective cohort study of peritonsillar abscess management and outcomes: the Multicentre Audit of Quinsies study

Mehanna¹

2016

J. Laryngol. Otol.

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Disinfection of flexible fibre-optic endoscopes out-of-hours: confidential telephone survey of ENT units in England – 10 years on

Abstract: An overall moderate improvement in the safety of out-of-hours endoscopy in the past 10 years cannot obscure the urgent need for universal compliance with national guidelines.

Cited by 4 publications

References 9 publications

A Manufacturer and User Facility Device Experience Analysis of Upper Aerodigestive Endoscopy Contamination: Is Flexible Laryngoscopy Different?

A Manufacturer and User Facility Device Experience Analysis of Upper Aerodigestive Endoscopy Contamination: Is Flexible Laryngoscopy Different?

Management of the most common ENT presentations

National prospective cohort study of peritonsillar abscess management and outcomes: the Multicentre Audit of Quinsies study

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